Covered person has become entitled to (or lost entitlement to) Medicare, Medicaid, Medi-Cal or SCHIP2

Drop coverage for the person who became entitled to Medicare, Medicaid, Medi-Cal, or SCHIP

Add the person who lost entitlement to Medicare, Medicaid, Medi-Cal, or SCHIP

Documentation required

Drop health coverage for yourself or any other covered individuals who are not newly Medicare, Medicaid, Medi-Cal, or SCHIP eligible.

Change of home address outside of plan service area

If you are enrolled in an HMO and move out of their service area, then you can elect new coverage

Does not apply to County Health Plan, dental or vision coverage

Employment Status Events

If you experiencethe following Event...

You may make the following change(s) within 31 days of the Event...

You may not make these types of changes...

You become newly eligible for benefits due to change in employment status or bargaining group

Enroll yourself, if applicable

Enroll your spouse/DP and other eligible dependents

Drop health coverage

Drop your spouse/DP and other eligible dependents

Change health plans

Enroll, drop or change plans if your employment change does not result in you being eligible for a new set of benefits

Spouse/DP obtains health benefits in another group health plan

Drop your spouse/DP from your health coverage

Drop your dependent children from your health coverage

Drop coverage for yourself

Proof of coverage in the other health plan required

Change health plans

Add any eligible dependents to your health coverage

Spouse/DP loses employment, experiences a termination of their employer’s contribution, or otherwise loses coverage for health benefits in another group health plan You or your dependents exhaust COBRA coverage under other group health plan

You experience a reduction in hours that results in a significant cost increase or an unpaid leave not covered by FMLA, CFRAetc. where the County will no longer be making a contribution

Drop your spouse/DP from your health coverage

Drop your dependent children from your health coverage

Drop coverage for yourself

Change health plans to a less expensive plan

No change is allowed unless the reduction in hours causes a loss of eligibility or a loss or significant reduction of the employer subsidy for medical (not FSA) coverage. Financial hardship (including due to a pay cut or reduction in hours) does not trigger the change in cost rule.

You experience an increase in hours (e.g. part-time to full-time) that results in a significant cost decrease or return from an unpaid leave (e.g. leave without pay) when the County was not making a benefit contribution

Add coverage for yourself

Add your spouse/DP, or dependent children to your health coverage

Change health plans

No change is allowed unless the increase in hours results in new eligibility or a significant change in the employer subsidy for medical (not FSA) coverage.

You return from Military leave

Enroll yourself, if applicable

Enroll your spouse/DP and other eligible dependents

Change health plans

Notes:

Rules above apply equally to IRS qualified and non-qualified dependents for consistency and ease of administration.

Have 60 days from loss or eligibility determination of Medicare, Medicaid, Medi-Cal or SCHIP to request special enrollment.

Effective Dates

The above benefit election changes are effective as follows:

Canceling Coverage: Effective date of change is generally the last day of the month after the event that allowed the change.

E.g., Spouse obtains other group coverage on the 1st of the month. Coverage for spouse ends on the last day of the prior month.

Adding new/changing coverage: Effective date of change is generally the first of the month following or coinciding with the event that allowed the change.

E.g., Married on the 1st of the month. Coverage for new spouse is effective on the 1st of the same month.

Married on the 2nd of the month. Coverage for new spouse is effective on the 1st of the following month.

New Hires: Effective on the 1st of the month following date of hire.

E.g., Hired June 1, 2010. Coverage is effective on July 1, 2010.

Hired June 9, 2010. Coverage is effective July 1, 2010.

Effective Date Exceptions:

Birth/Adoption: Effective on the 1st of the month following date of birth/adoption. Medical plans will cover a newborn under the subscriber’s coverage from date of birth through the end of the birth month. Submit paperwork to your payroll clerk or Human Resources early and no later than 31 days from the date of birth to ensure medical coverage for the child.